How Some Health Care Providers Help Poor People, Defraud U.S.


As the Obama administration cranked up efforts this week to find and eliminate billions of dollars in faulty Medicare and Medicaid payments, a review of court cases shows that Tennessee has been home to several fraud schemes , The Tennessean reports. Some cases involve clearly egregious behavior. A typical example is a person who jumps from location to location, steals doctors' provider identification numbers and bills the federal health programs for services that are never provided. Other times, prosecutions involve seemingly well-intentioned people who make bad, and illegal, decisions.

Glenesha Bowling-Moye and Tabitha Jones were sentenced to 18 and 12 months imprisonment, respectively, on federal health-care fraud and money-laundering charges. They had pleaded guilty to conspiring to defraud Medicare and TennCare of $1.1 million. The two started a business called EBC Healthcare in 2006. The business provided much-needed services to the elderly in some of Nashville's poorest neighborhoods, from cleaning houses to driving people to medical appointments and Walmart. The problem: They billed Medicare and TennCare for psychotherapy sessions and nurse practitioner home visits but were not providing those professional services. “The key is Medicare doesn't pay for (cleaning and running errands), period,” said one investigator.

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